Medial epicondylitis: Current diagnosis and treatment options

Abstract

IntroductionWhile commonly referred to as “golfer's elbow,” medial epicondylitis (ME) is a syndrome that more frequently presents in overhead throwing athletes and manual laborers. Repeated eccentric loading of the common flexor tendon attachment to the medial epicondyle leads to a spectrum of inflammation, microtrauma, and degeneration. Ulnar neuritis may be present in up to 60% of patients with ME, and its identification is imperative as up to 63% of these patients will experience persistent neurological symptoms. This review sought to provide a comprehensive reference for the current management of ME. Treatment and outcomesConservative management remains the mainstay for ME, with up to 85–95% of patients responding to initial treatment. Possible combinations for conservative treatment include trials of topical and/or oral NSAIDs, physical therapy, reduced activity levels, corticosteroid injections, electrical stimulation, and iontophoresis. Despite initial response to therapy, many patients experience symptom recurrence and progress to surgical intervention. Operative interventions include a variety of open, percutaneous, and arthroscopic approaches, with technique selection depending on patient presentation as well as physician experience and preference. Novel interventions for refractory ME treatment include injections of neutrophil-reduced platelet-rich plasma, and transcatheter arterial embolization. Bone marrow aspirate injections have also demonstrated some success in patients with lateral epicondylitis, but this modality has not yet been studied in ME to date. ConclusionsWhile less frequently encountered when compared to other upper extremity pathologies, ME remains a clinically important topic due to the prevalence of refractory cases and the constantly evolving treatment possibilities for the condition.